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Postoperative irradiation in cervical cancer: prognostic factors and outcome
1Mallinckrodt Institute of Radiology, Department of Radiation Oncology-Box 8224, Washington University School of Medicine, 4921 Parkview Place, Lower Level, St. Louis, MO 63110, USA.
Purpose:
The aim of this study was to evaluate prognostic factors and outcomes in patients with cervical cancer who underwent hysterectomy followed by pelvic irradiation.
Methods:
This was a retrospective chart review of 140 patients with carcinoma of the cervix. The indications for irradiation were an incidental finding of invasive cancer, positive lymph nodes, parametrial extension of tumor, and positive or close margins.
Results:
The 10-year cause-specific and overall survival rates were 72% and 69%, respectively. Recurrences developed at the following sites: five in the pelvis, four in the pelvis and with distant metastasis, and 13 with distant metastasis. Parametrial extension of tumor was the only significant prognostic factor for developing recurrent disease (p=0.004). Complications were grade 3 in 10 and grade 4 in 18. Leg edema occurred in patients undergoing radical hysterectomy and lymph node dissection, but not in patients undergoing simple hysterectomy (p=0.01), and was more likely if irradiation was begun within six weeks of surgery compared with starting irradiation after six weeks (p=0.02).
Conclusion:
Pelvic irradiation produced pelvic control of disease in 94%. Distant metastasis was the most common site of failure. Chronic toxicity was greatest if irradiation was begun less than six weeks postoperatively.
